How Home-Based Care Companies Are Carving Out a Space in Hospital-at-Home Programs

When it comes to running a successful hospital-at-home model, many have stressed the importance of having a home care component to complement clinical service offerings and provide assistance with patients’ everyday activities.

For some home care providers, this fact — and the launch of several new hospital-at-home programs since the start of the pandemic — has resulted in a rise in business partnerships.

“Adoption of [the hospital-at-home concept] happened faster in other developed countries like Canada, Australia and so forth, but the acceleration of the model in the U.S. market has recently picked up amid COVID because of the [government] initiative,” Kaustubh Savant, senior industry analyst of health care and life sciences at consulting firm Frost & Sullivan, told Home Health Care News.

Specifically, Savant was referring to the “Acute Hospital Care At Home” waiver program, announced by the U.S. Centers for Medicare & Medicaid Services (CMS) in November 2020. The waiver gave hospitals and health systems “unprecedented” flexibility to shift care into the home, which created a turning point for the hospital-at-home model.

“Given the tremendous strain COVID-19 is putting on our health care system, access to home hospital care has never been more important,” Travis Messina, CEO of home-based care innovator Contessa Health, told HHCN at the time.

Beyond regulatory flexibility, the COVID-19 relief measure allowed approved hospitals to receive reimbursement for their in-home care efforts. Effectively, the waiver meant new players could seamlessly enter the market, avoiding many of the start-up hurdles past hospital-at-home programs faced.

As of Sept. 2, 156 hospitals and 69 systems have been approved for the CMS waiver, according to publicly available data.

“I would say it has expanded to 10 times as many programs since the launch,” Savant said.

Even with hospital-at-home becoming more common, setting up and maintaining a successful program can be daunting. This is where partnerships with home care providers come in handy.

“It’s not only the hospital-at-home program in itself that plays a vital aspect in reducing rehospitalizations in emergent care, but that of the non-medical component of really assisting with those activities of daily living,” Sheila Davis, senior vice president of area operations at Always Best Care, told HHCN.

Roseville, California-based Always Best Care is a home care franchise company that operates across 209 territories in 30 states.

Always Best Care has joined forces with hospital-at-home programs in many of the territories the company operates in. Still, the majority of these partnerships began with Always Best Care educating hospital-at-home programs about the value-add of home care services.

“Some hospital organizations truly felt that non-medical services were just that of an escort agency, or a respite care agency to relieve someone, or maybe just housekeeping or meal prep,” Davis said. “They didn’t fully understand the entire extent of what non-medical industries could provide.”

Part of the reason this education barrier exists is because of how siloed the health care sector is, according to Davis.

Home care providers have often received the moniker of “the eyes and ears” in the home. For Always Best Care, this has meant aiding its hospital-at-home partners in bringing critical symptoms to the attention of the clinician.

“A non-medical home care partner can sometimes identify when a particular client or patient is starting to show signs and symptoms of congestive heart failure, or if they’re starting to gain weight, or if they have fluid retention, maybe we noticed an unusual breathing pattern,” Davis said. “We aren’t skilled providers in any aspect, but … in that recognition of such, we can advise the skilled care provider.”

It’s not just home care companies like Always Best Care working with hospital at home. Other types of home-based care providers are too.

One area where these partnerships have been particularly useful for hospital-at-home programs is on the staffing side, Summer Napier, CEO and owner of Healing Hands Healthcare LLC, told HHCN.

“There are probably thousands of hospitals that want to do a hospital-at-home program, but with the current staffing crisis we have in health care, they don’t always have the opportunity to send their own staff out into the homes,” Napier said. “We have the available staff. We know how to provide post-acute care in the home. We’re familiar with the needed resources to make sure that that patient is well taken care of.”

Wichita Falls, Texas-based Healing Hands Healthcare is a for-profit in-home care provider that serves 22 counties in Texas. Its service offerings range from skilled nursing care and therapy services, to medical license social working and private-duty home care.

Currently, Healing Hands has a contract to provide staffing for two hospital-at-home programs. As a partner to these programs, the company provides nursing and therapy visits in the home, as well as helping to administer medication.

Napier’s advice for home-based care providers looking to form relationships with hospital-at-home programs is that it’s important to have the right staff in place.

“Make sure that your staff is equipped and prepared for what it takes to run higher-acuity patients in the home,” she said. “For example, traditionally a lot of nurses want to work in home health because they enjoy the flexibility of their job. … When you are working with a hospital-at-home program and accept higher-acuity patients, that mindset of the staff has to change.”

On the home care side, it’s important for providers to be persistent when courting hospital-at-home partnerships, Davis added.

“I’m not going to say that the first time we went to a hospital they immediately sat down with us. … It’s a continuous education process,” she said. “You have to provide facts and outcomes that prove how the [home care] model can be assistive.”

Overall, Davis believes that these kinds of partnerships are a meaningful opportunity for home care providers.

“It’s another payer source, whether it be through the hospital themselves, or through a Medicare Advantage plan or some alternative source,” she said. “Plus, once we get in that home, through the hospital-at-home program, the family then sees what a difference a non-medical agency can have and the effect on their loved ones.”